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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ,, <br /> APPLICATION AOR-S_ANI ATION PERMIT Permit No. - ��- <br /> -------------------------- -------- -- --- (CompleteAn Duplicate) <br /> Date issued <br /> .-..-- This Permit Expires 1 Year From Date Issued - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. <br /> This application ¢ode in compliance with County OrdinancePot�j49.* h vFis�p �'�•� Z <br /> e1, <br /> ce <br /> JOB ADDRESS AND LOCATION-- --- Z�Y ---- - — <br /> Owner's Name-----)3 T -- ---- AF 13 -t7Y. Phone--- <br /> Address_------------- 0--- ------------ <br /> - / ------------ ------ v ------ ----------- -----------------•----------------- :... <br /> Contractor's Name-------------- ----4°C,?__/v—--------•-•------------ - ------ Phone------ �f---------------- <br /> - - --------- ------- -------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ .x. Number of bedrooms __72, Number of baths---_---- Lot size ----- _- -------- -------- -------------------------------- <br /> Water Supply. Public system ❑ Community system ❑ PrivateR Depth to Water Table /VWt _ <br /> Character of sail to a depth of 3 feet- Sand K Gravel ❑ Sandy Loam ❑ Clay Loam-Q Clay ❑ AdobeZ] Hardpan <br /> Previous Application Made: {If yes,date----------- } No rV New Construction: Yes 2( No ❑ FHA/VA: Yes ❑ NQV <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available/within 200 feet.) <br /> Tank: Distance from nearest well---/a_1?_Distanc froT un&ionl�_ Material <br /> ---C_ re— <br /> _ / ����p <br /> � <br /> ------- Capacity--/---.No, of compartments._.____. Size_[ _ . $ ___Liquid de th_. <br /> Disposal Field: Distance from nearest well---/O.C11 Distance from foundation-.-16........Distance to nearest lot line---ld t/ <br /> Number of lines------4P------------"-------------Length of each line._ ....rLr.C}-____�--....-.Width of trench__., `_.4`_ ..------------- <br /> Type <br /> _. ___..___Type of filter material__AP.�_--.-Depth of filter material__._49_1--------- length-----------t�j--'_U--------------.---_--- <br /> Seepage Pit: Distance to nearest well- _/Q_V_-----Distance from foundaati __.__�✓�__--- Distance to nearest lot iine...6Z7 <br /> Number of p,ts... _/.__.-__.___Lining mater'sal,� lv5ize: Diameter .fir..___.Deptn___ .5-l---------------• <br /> 10 <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material__.__.-_.___-_.._---_----------__-_-. <br /> El Size: Diameter- -- ----- -------- -------------Depth----------------------------- ---- - ------ --------Liquid Capacity....------------------------gals. <br /> Privy: Distance from nearest well----------------------------------------------- -Distance from nearest building---.-_--------_.._--._-_-------..--_-__. <br /> ❑ Distance to nearest lot line ------------- ------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe) --- --- ------------------------------------------------------- . ---- <br /> --------- ---- ---------------•------•-------------------------------------•- ---------------------------------•-------------------------------------------- -------------------- •---------------•----- ------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- <br /> ---- - e----------------------------------------------•------------------------------------------------------------------------------•------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in'accordance with San Joaquin County <br /> ordinances, ate laws, and rule and regulatio a San Joaquin Local Health District. <br /> (Signed ----- -- - - -------------------- -------------------- ------------- -------------ji: wne and/or Contractor) <br /> SY .-----°----- ------------------------------------------- - ---------- <br /> ------------------------ (Title) --.._... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._.. .. `�T� -------------------------- DATE , = � �� ----------------------- <br /> - ._.-. / <br /> REVIEWEDBY------------- ------------------------------ ---- ------- -------------- ------------------ ------ DATE =....._..---------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ------------------------.}-�- --- ------------- ------------------------- ----------------- DATE--------------------------A------�- <br /> Alterations and/or recommendations:. --------. �f .... -- --- ------ - -----------------Tr A ----------------------------------- <br /> -------------­-------------- <br /> -------- --• ---------------- <br /> --------------- - ---------------------- ------------- - ------ -------------------------------- ----------------------------------------- ----------- --------- ------------------ ------- -------- ---•--- <br /> 4 FINAL INSPECTION /-------- Date --------- <br /> SAN JOAQUIN LOCAL'HEALTH DISTRICT <br /> 1601 E.Hatetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />